Cardiac resynchronization therapy has become an integral part in the step-care approach to manage patients with heart failure. Cardiac imaging remains central to appropriate patient selection and optimal left ventricular lead placement, both of which are important determinants of response to cardiac resynchronization therapy. One of the biggest limitations with current imaging modalities is the inability of a single technique to address each, the anatomic (venous anatomy), mechanical (dyssynchrony), and structural (extent of scar location) issues accompanying cardiomyopathy. We present here the potential concept of using cardiac computed tomography as a single modality to acquire functional and anatomic information, and also to show the possibility of integrating this with real time fluoroscopy.